20021134 Ver 1_Complete File_20020717

N. C. DEPARTMENT OF TRANSPORTATION
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' COMMENTS:
021 134'

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STATE of NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GovERNoR
July 16, 2002
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
LYNDO TIPPETT
SECRETARY
Subject: Replacement of existing pipe conveying an unnamed tributary to Crabtree
Creek on SR 1821 (Philcrest Road) in Wake County.
The North Carolina Department of Transportation (NCDOT) proposes to replace
an existing pipe conveying an unnamed intermittent tributary to Crabtree Creek on SR
1821 (Philcrest Road) in Wake County (Figures 1-3). The existing structure is a 36 inch
corrugated steel pipe that is 50 feet long. The pipe has rusted out underneath the
roadway, resulting in the creation of a sinkhole in the roadway which is now closed to
traffic. The NCDOT is proposing to replace the existing structure with a 60 inch
corrugated metal pipe that is 70 feet long.
Impacts to Waters of the United States
Construction of the project will necessitate impacts to waters of the United States
in the Neuse River Basin. The project crosses an unnamed intermittent tributary to
Crabtree Creek (DWQ Index No. 27-33-(10), Best Usage Classification C NSW).
Permanent impacts at the site associated with the replacement of the structure and
minimal amounts of fill and rip rap to protect the structure include <0.01 acre fill in
surface water and 39 linear feet existing channel impacted.
Waters of the U.S. Mitigation
Avoidance: All surface waters not affected by the project will be protected from
unnecessary encroachment. No staging of construction equipment or storage of
construction supplies will be allowed in or near surface waters.
Minimization: The side slopes have been steepened to the extent possible at
jurisdictional sites. Strict enforcement of sedimentation and erosion control Best
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
WAKE COUNTY. NOr,TH CAROLINA - SHEET NUMBER 38
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Management Practices for the protection of wetlands and surface waters will be enforced
during project construction. Continued coordination will occur with maintenance forces
and the Environmental Officer during construction to minimize impacts to these sites.
Compensatory Mitigation: Construction of the project will result in only minimal
impacts to waters of the United States. Impacts have been avoided and minimized to the
maximum extent possible during the design process. Due to minimal impacts,
compensatory mitigation for stream impacts will not be provided for this project.
Riparian Buffer Impacts
The construction of the project involves a road crossing of a stream that is subject
to the Neuse River Riparian Buffer Rule. The unnamed intermittent tributary to Crabtree
Creek is not depicted on the most recent version of the Raleigh West, North Carolina
topographic quadrangle (USGS, 1993) (Figure 1). However, the unnamed intermittent
tributary to Crabtree Creek is depicted on the Soil Survey of Wake County (USDA-Soil
Conservation Service, 1970). The construction impacts 534 square feet in zone 1, 0
square feet in zone 2, and 39 linear feet of riparian buffer. Based on impacts to the
riparian buffer, this project is exempt.
Protected Species
Plants and animals with federal classifications of Endangered, Threatened,
Proposed Endangered and Proposed Threatened are protected under provisions of Section
7 and Section 9 of the ESA. As of February 27, 2001, there are four federally protected
species listed for Wake County. They include bald eagle (Haliaeetus leucocephalus),
Michaux's Sumac (Rhus michauxii), dwarf wedgemussel (Alasmidonta heterodon) and
red-cockaded woodpecker (Picoides boralis).
dwarf wedgemussel --Biological Conclusion: No Effect
The stream at the project limits is an intermittent stream, which does not provide
suitable habitat for the dwarf wedgemussel. A review of the NHP rare and unique habitat
database did not reveal the presence of this species within 1.6 km (1.0 mi) of the project
study area. Impacts to this federally protected species will not occur from project
construction.
Michaux's sumac--Biological Conclusion: No Effect
Suitable habitat for Michaux's sumac is present along the irregularly maintained
roadside shoulder. A plant-by-plant survey was conducted during the site visit on July
11, 2002 by NCDOT Division Environmental Officer Chris Murray. No populations of
Michaux's sumac were observed during the site visit. A review of the NHP rare and
unique habitat database did not reveal the presence of this species within 1.6 km (1.0 mi)
of the project study area. Impacts to Michaux's sumac will not occur from project
construction.
bale eagle--Biological Conclusion: No Effect
Although it is possible that eagles may occasionally fly over the project, the lack
of appropriate habitat for feeding, nesting, roosting and perching, makes it unlikely that
eagles use specific sites at the project. No bald eagle foraging or nesting or other activity
was observed at the project study area during the site visit July 11, 2002. A review of the
NHP rare and unique habitat database did not reveal the presence of this species within
1.6 km (1.0 mi) of the project study area. Impacts to bald eagle will not occur from
project construction.
red-cockaded woodpecker--Biological Conclusion: No Effect
The project study area contains no foraging habitat and no nesting habitat for red-
cockaded woodpecker. There is no nesting habitat within 1.0 mile of the project study
area. No red-cockaded woodpeckers were observed during the site visits on July 11,
2002. A review of the NHP rare and unique habitat database did not reveal the presence
of this species within 1.6 km (1.0 mi) of the project study area. Based on available
information, the construction of this facility will not impact red-cockaded woodpecker.
Summary
NCDOT proposes to replace an existing pipe conveying an unnamed intermittent
tributary to Crabtree Creek on SR 1821 (Philcrest Road) in Wake County. Permanent
impacts at the project include <0.01 acre fill in surface water and 39 linear feet existing
channel impacted. The construction impacts 534 square feet in zone 1, 0 square feet in
zone 2, and 39 linear feet of riparian buffer. Based on impacts to the riparian buffer, this
project is exempt.
Application is hereby made for a Department of the Army Section 404
Nationwide Permit (NWT) 3. Additionally, this application provides notification to the
NCDWQ as Section 401 Water Quality Certification (WQC) No. 3376 will be utilized for
construction of this project. The NCDOT will comply with all applicable NWP, WQC
and riparian buffer conditions. A pre-construction notification is attached with this
request. If you have any questions or need additional information, please contact me at
,[phone].
Sincerely,
Christopher A. Murray, P.W.S.
Environmental Officer
cc: Mr. John Dorney, NCDWQ, Raleigh
Mr. Brandon Jones, NCDOT District Engineer, Raleigh
Mr. Adam Stephenson, NCDOT, Raleigh

Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http://www.saw.usace.army.miI/wetlands/Perm app.htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.army.mil/wetlandslregtour.htm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
Page 1 of 11
CAMI A Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this firm, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at htta:jYwww.saw.usace.army.mil/wetlands/nwpfinalFedReg.pdf.
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field,office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service. Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h?,o.chnr.state.nc.us/ncwetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 11
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
. ' I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
? 401 Water Quality Certification (WQC 3376 does not require written concurrence
from DWQ)
? Riparian or Watershed Buffer Rules (Activities associated with project construction
are listed as "exempt")
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 3
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: NCDOT/Christopher A. Murray
Mailing Address: 2612 N. Duke Street Durham NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 3 of 11
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
J in Wake County.
1. Name of project: SR 1821 (Phil;st Road
2. T.I.P. Project Number (NCDOT Only): NCDOT Division Project ,non-TIP
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Wake Nearest Town: Raleigh
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From US 70 (Glenwood Ave.)
an
travelling southeast, turn left and travel north on SR 1820 (Lead Mine Road) , turn right d
travel east on SR 1821 to project site.
5. Site coordinates, if available (UTM: or Lat/Long): UTM 17 710148E 3968688N
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application: Site is
surrounded by wooded land and reidential housing
7. Property size (acres): Project footprint is 0.05 acres.
8. Nearest body of water (stream/riverr/sound/ocean/lake): Unnamed intermittent tributary to
Crabtree Creek.
9. River Basin: Neuse River
(Note - this must be one of North. Carolina's seventeen designated major river basins. The
River Basin map is available at htta):Hh2o.enr.state.nc.us/admin/maps/.}
Page 4 of 11
10. Describe the purpose of the proposed work: Proposed pipe replacement at SR 1821
(Philcrest Road). The existing 50 foot corrugated steel pipe will be replaced with an 70 foot
corrugated metal pipe.
11. List the type of equipment to be used to construct the project: Excavator and Backhoe.
12. Describe the land use in the vicinity of this project: Wooded land and residential housing_
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
No previous project jurisdictional determination or permit history associated with site
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: None anticipated.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
Page 5 of 11
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://N? fenia. ^oN .
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0.0 acre on site.
Total area of wetland impact proposed: 0.0 acre on site.
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on map) linear feet) Before Impact lease specify)
Site 1 Pipe replacement 20 UT Crabtree Ck. 3 feet Intermittent
Placement of Rip Rap
Site 1 At Inlet and Outlet for 19 UT Crabtree Ck. 3 feet Intermittent
stabilization only.

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and 1ooding), relocation (include linear feet before and after, and net losstgain),
stabilization activities (cement wall, rip-rap, crib wall, g;abions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included
Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
,,i,Av"-.usgs.oov. Several intemet sites also allow direct download and printing of USGS maps (e.g., vvyo w.topozone.coin,
www.mapguest.com, etc.).
Cumulative impacts (linear distance: in feet) to all streams on site: 39 feet existing channel
impacted (20 feet for pipe replacement and 19 feet for streambank stabilization at inlet and
outlet with rip rap)
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S.
Open Water Impact Area of Name of Waterbod
y Type of Waterbody
Site Number Type of Impact* Impact
(if applicable) (lake, pond, estuary, sound,
(indicate on ma) (acres) bay, ocean, etc.)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
Page 6 of I I
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
All surface waters not affected by project construction will be protected from unnecessary
encroachment. The side slopes at the jurisdictional site has been steepened to the maximum
extent possible. Strict enforcement of Best Management Practices for the protection of wetlands
and surface waters will be enforced during construction. Only the smallest amount of fill
necessary to complete the project will be placed in waters of the United States.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
Page 7 of 11
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration., enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Not Applicable.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at liul)://h2o.enr.state.nc.us/-vvrv/index.htin. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): NIA
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
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and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 534 3
2 0 1.5
Total 534
* Zone 1 extends out 30 feet perpendicular trom near bank of channel; Gone 1 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Existing: 0.01 acre impervious surface of 0.05 acre total project size. Proposed: 0.01 acre
impervious surface of 0.05 acre total project size. Erosion and sediment control devices along
the project may be comprised of silt fence. All temporarily disturbed areas will be reveaetated
after construction.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
The project will not generate wastewater.
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X1H. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (I 5A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing; time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 10 of 11
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
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